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An estimated one million people in Madagascar are diabetic, but only about half of them know it. Finding the other half presents a major challenge for this large, island nation in which 80 per cent of the population live in rural areas where few people have ever heard of this chronic and potentially deadly disease. With the country’s underfunded public health sector barely functioning, this task has mainly fallen to the Madagascan Diabetes Association which dispatches its doctors and nurses to the provinces to conduct blood sugar tests and raise awareness at fairs, schools and health centres.